Plan Materials and Resources
Member Materials
2020 Annual Notice of Changes (ANOC) | English Español 中文 | ![]() |
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2020 Summary of Benefits | English Español 中文 | ![]() |
2020 Evidence of Coverage | English Español 中文 | ![]() |
2020 Provider and Pharmacy Directory | Bronx Brooklyn Manhattan Queens | ![]() |
2020 Formulary | English Español | ![]() |
2020 Extra Help Premium Summary Table | English Español 中文 | ![]() |
Multi-language Insert | English Español 中文 Creole Русский Italiano 한국 | ![]() |
Enrollment Form | English Español 中文 | ![]() |
Prescription Drug Claim Form | English | ![]() |
Appointment of Representative Form | English Español | ![]() |
Health Care Proxy Form & Information* | English Español 中文 Creole Русский Italiano 한국 | ![]() |
Part D Coverage Determination Form | English | ![]() |
Member Reimbursement Form | English (coming soon) | ![]() |
Part D Coverage Redetermination Form | English | ![]() |
Prescription Drug Mail Order Form | English | ![]() |
Privacy Notice | English | ![]() |
Notice of Non-Discrimination | English Español 中文 Creole Русский Italiano 한국 | ![]() |
2020 Medicare Star Ratings | English Español 中文 | ![]() |
Member Resources
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CMS Best Available Evidence Policy |
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H2168_MKT20-11
This page was last modified on October 22, 2019
This page was last modified on October 22, 2019